Friday, 20 September 2013

*mums world* sleep topic 19/09/2013

Lots of young children find it difficult to settle down to sleep, and they wake up during the night. For some people, this might not be a problem.
If you're happy for your child to go to bed at the same time as you, that's fine.
But if you or your child are suffering from lack of sleep, you may like to try some of these suggestions. Every child is different, so do only what you feel comfortable with and what you think suits your child.
If your child won’t go to bed
Decide what time you want your child to go to bed.
Close to the time that your child normally falls asleep, start a 20-minute ‘winding down’ bedtime routine. Bring this forward by 5-10 minutes a week (or 15 minutes, if your child is in the habit of going to bed very late) until you get to the bedtime you want.
Set a limit on how much time you spend with your child when you put them to bed. For example, read only one story, then tuck your child in and say goodnight.
Give your child their favourite toy, dummy (if they use one) or comforter before settling into bed.
If your child cries, leave them for 1 minute before going back in and settling them down again. Increase the time by one minute more each time.
Don’t pick them up or take them downstairs. If your child gets up, put them back to bed again.
Leave a drink of water within reach and a dim light on if necessary. Don’t turn on any extra lights when u enter the room.
If you keep checking to see if your child is asleep, you might wake them up, so leave it until you're certain that they're asleep.
You might have to repeat this routine for several nights.
If you try this, you will need to try to be firm and not give in.
If you child keeps waking during the night
By the time your child is six months old, it’s reasonable to expect them to sleep through most nights. However, up to half of all children under five go through periods of night waking. Some will just go back to sleep on their own; others will cry or want company. If this happens, try to work out why your child is waking up.
For example:
Is it hunger? If your child is a year or older, some cereal and milk last thing at night might help them to sleep through the night.
Are they afraid of the dark? You could use a nightlight or leave a landing light on.
Is your child waking up because of night fears or bad dreams? If so, try to find out if something is bothering them.
Is your child too hot or too cold? Adjust their bedclothes or the heating in the room and see if that helps.
If there’s no obvious cause, and your child continues to wake up, cry or demand company, you could try some of the following suggestions:
Scheduled waking. If your child wakes up at the same time every night, try waking them 15-60 minutes before this time, then settling them back to sleep.
Let your child sleep in the same room as a brother or sister. If you think your child may be lonely, and their brother or sister doesn’t object, put them in the same room. This can help them both sleep through the night.
Teach your child to get back to sleep by themselves. First check that everything is alright. If it is, settle your child down without talking to them too much. If they want a drink, give them water but don’t give them anything to eat. For this approach to work, you need to leave them in their cot or bed. Don't take them downstairs or into your bed. Let them cry for around 1 minute before you return, increase a minute each time. On the third night or when it takes less time for them to settle wait 5-10 minutes before you check on them. Over the next few nights, gradually increase the amount of time you leave them before checking. It might take a week or two but if you keep the routine going, your child should start falling asleep on their own.
Tackle it together. If you have a partner, agree between you how to tackle your child’s sleeping problems. You don’t want to try to decide what to do in the middle of the night. If you've both agreed what's best for your child, it’ll be easier to stick to your plan.

Extra help with sleeping problems
It can take patience, consistency and commitment, but most sleep problems can be solved. If you’ve tried the suggestions on these pages and your child’s sleeping is still a problem, talk to your GP or health visitor.
They may have other ideas or may suggest you make an appointment at a sleep clinic, if there is one in your area. Sleep clinics are usually run by health visitors or clinical psychologists who are trained in managing sleep problems. They can give you the help and support you need.
In the meantime, if you’re desperate, try to find someone else to take over for an occasional night, or someone whom your child could stay with. You’ll cope better if you can catch up on some sleep yourself.



Baby sleep advice
Some babies sleep much more than others. Some sleep for long periods, others in short bursts. Some soon sleep through the night and some don’t for a long time. 

Your baby will have their own pattern of waking and sleeping, and it’s unlikely to be thesame as other babies you know.

It’s also unlikely to fit in with your need for sleep. Try to sleep when your baby sleeps. If you’re breastfeeding, in the early weeks your baby is likely to doze off for short periods during a feed. 

Carry on feeding until you think your baby has finished or until they’re fully asleep. This is a good opportunity to try to get a bit of rest yourself

If you’re not sleeping at the same time as your baby, don’t worry about keeping the house silent while they sleep. It’s good to get your baby used to sleeping through a certain amount of noise.
How can I get my baby used to night and day being different?
It’s a good idea to teach your baby that night time is different to daytime from the start.
During the day, open curtains, play games and don't worry too much about everyday noises when they sleep.
At night, you might find it helpful to:
keep the lights down low
not talk much and keep your voice quiet
put your baby down as soon as they’ve been fed and changed
not change your baby unless they need it
not play with your baby
Soon, your baby will learn that night time is for sleeping.
Where should my baby sleep?
For the first six months your baby should be in the same room as you when they're asleep, both day and night. Particularly in the early weeks, you may find that your baby only falls asleep in your or your partner's arms, or when you're standing by the cot. 

You can start getting your baby used to going to sleep without you comforting them by putting them down before they fall asleep or when they’ve just finished a feed. 

It may be easier to do this once your baby starts to stay alert more frequently or for longer.
Is it important to have a routine from the beginning?
Newborn babies will sleep on and off throughout the day and night. It can be helpful to have a pattern, but you can always change the routine to suit your needs. For example, you could try waking your baby for a feed just before you go to bed in the hope that you’ll get a long sleep before they wake up again.
Establishing a bedtime routine
You may feel ready to introduce a bedtime routine when your baby is around three months old. Getting them into a simple, soothing bedtime routine can be helpful for everyone and can help prevent sleeping problems later on. It's also great one-to-one with your baby. The routine could consist of:
having a bath
changing into night clothes and a fresh nappy
brushing their teeth (if they have any!)
putting to bed
reading a bedtime story
dimming the lights in the room to create a calm atmosphere
giving a goodnight kiss and cuddle
singing a lullaby or having a wind-up musical mobile that you can turn on when you've put your baby to bed
Leave the room while your baby is still awake, happy and relaxed and they will learn how to fall asleep on their own in their cot. Try to avoid getting them to sleep by rocking or cuddling them in your arms. If they get used to falling asleep in your arms, they may need nursing back to sleep if they wake up again.

As your child gets older, it can be helpful to keep to a similar bedtime routine. Too much excitement and stimulation just before bedtime can wake your child up again. Spend some time winding down and doing some calmer activities, like reading. 
Avoid bedtime feasts
Leave a little time between your baby's feed and bedtime. If you feed your baby to sleep, feeding and going to sleep will become linked in your baby's mind. When they wake in the night, they'll want a feed to help them go back to sleep.
 

How much sleep is enough?
Just as with adults, babies’ and children’s sleep patterns vary. From birth, some babies need more sleep or less sleep than others. This list shows the average amount of sleep that babies and children need during a 24-hour period, including daytime naps.
Birth to three months: most newborn babies are asleep more than they are awake. Their total daily sleep varies, but can be from eight hours, up to 16-18 hours. Babies will wake during the night because they need to be fed. Being too hot or too cold can also disturb their sleep.
Three to six months: as your baby grows, they’ll need fewer night feeds and be able to sleep for longer. Some babies will sleep for eight hours or longer at night. By four months, they could be spending around twice as long sleeping at night as they do during the day.
Six to 12 months: at this age, night feeds should no longer be necessary, and some babies will sleep for up to 12 hours at night. Teething discomfort or hunger may wake some babies during the night.
12 months: babies will sleep for around 12-15 hours in total.
Two years: most two-year-olds will sleep for 11-12 hours at night, with one or two naps in the daytime.
Three to four years: most will need about 12 hours sleep, but this can range from 8 hours up to 14. Some young children will still need a nap during the day.
Coping with disturbed nights
Resist the urge to rush in if your baby murmurs in the night. Leave them for a few minutes and see if they settle on their own.
Having said that, newborn babies invariably wake up repeatedly in the night for the first few months and disturbed nights can be very hard to cope with.
If you have a partner, ask them to help. If you’re formula feeding, encourage your partner to share the feeds. If you’re breastfeeding, ask your partner to take over the early morning changing and dressing so that you can go back to sleep. 

Once you’re into a good breastfeeding routine, your partner could occasionally give a bottle of expressed breast milk during the night. If you’re on your own, you could ask a friend or relative to stay for a few days so that you can sleep.
Sleep problems
All new babies change their patterns. Just when you think you have it sorted and you've all had a good night's sleep, the next night you might be up every two hours.
Be prepared to change routines as your baby growns and enters different stages. And remember, growth spurts, teething and illnesses can all affect how your baby sleeps.
If your baby is having problems sleeping or you need more advice about getting into a routine, speak to your GP, midwife or health visitor.

Many children experience nightmares and night terrors, but most grow out of them. They don't cause any long-term harm to your child.
Night terrors are very different from nightmares.
A child having night terrors may scream and thrash around, and may not recognise you if you try to comfort them. This behaviour occurs just as they come out of a cycle of deep sleep. Your child will not be fully awake during these episodes and will have no memory of theirbehaviour the next morning.
Nightmares, on the other hand, occur during the lighter stage of sleep, when the child is dreaming. They may wake up from the nightmare and, depending on their age, may be able to remember and describe the bad dream to you.
Both night terrors and nightmares in children are described in more detail below, with advice on what you should do.
Night terrors
Night terrors are common in children aged three to eight years old. A child who experiences night terrors may scream, shout and thrash around in extreme panic, and may even jump out of bed. Their eyes are open, but they are not fully awake.
The episodes usually occur in the early part of the night and can continue for several minutes, for up to 15 minutes.
Why they happen
Night terrors are more common in children with a family history of night terrors or sleepwalking behaviour.
A night terror attack may be triggered by:
anything that increases your child's amount of deep sleep, such as tiredness, fever or certain drugs
anything that makes your child more likely to wake from deep sleep, such as excitement, anxiety or sudden noise
What you should do
The best thing you can do if your child is having an episode of night terrors is to stay calm and wait until the episode passes, making sure your child is safe.
Night terrors can be frightening to witness, but they don't cause any harm to your child. You shouldn't attempt to wake them when they are having the episode.
Your child may not recognise you and may become more agitated if you try to comfort them.
Once your child has come out of the attack, it is safe to wake them and, if necessary, encourage them to use the toilet before settling them back to sleep.
If your child returns very quickly into deep sleep, they may have another episode. Making sure they are fully awake before they go back to sleep can break this cycle.
Your child will not remember the episode the next morning, but it may still help to have a general chat to find out if anything is worrying them and triggering their attacks. It also helps if they have a relaxing bedtime routine.
If the night terror attacks are frequent and occur at a specific time every night, you may find that waking your child breaks the cycle. Wake your child 15 minutes before the anticipatedtime of the attack every night for seven days. This can disrupt their sleep pattern enough to stop the attacks without affecting sleep quality.
When you should seek help
Most children grow out of night terrors. However, you should talk to your doctor if they are occurring several times a night or are very frequent (occurring most nights). Your GP will be able to check whether something is causing them that could be easily treated. For example, large tonsils could be causing breathing problems at night and waking your child.
Cot to bed
Ready for a bed?
Ideally you should aim to keep your toddler in a cot for as long as possible but generally by the age of 3 years, most children have moved to a bed. A sure sign that a child needs to be transferred to a bed is when they persist in attempting to climb out of the cot or are successful in escaping!
Your daughter is on the young side for such a move so to keep her in it you’ll have to give her the incentive to want to stay there. If you give in and take her into your bed, the waking is likely to continue – after all, snuggling up with mum and dad is the ultimate reward for her night time waking. At the same time, she may develop inappropriate sleep associations and lose the ability to self-settle alone during the night.
Make it gradual
A gradual retreat program will help teach your daughter to settle alone at bedtime and go back to sleep by herself during the night. This technique will minimise crying and is less likely to disturb her baby brother and the lucky parent whose turn it is to stay in bed! 
Gradual retreat is a method of gradually distancing yourself from your daughter little by little until she no longer needs your presence to fall asleep at bedtime. It should teach her how to return to sleep independently during the night.
STEP 1
After her usual bath and bedtime story routine, get her into bed with whatever cuddlies she sleeps with, and stroke her arm or shoulder as she settles.
STEP 2
Stop stroking and gently pat her to sleep. After a couple of minutes of steady patting start to pat intermittently, with gradually increasing intervals between contact.
STEP 3
Place a hand very lightly on her and rest it there for a couple of minutes. Then remove your hand and quietly “shhhhhhh” her as she drifts off.
STEP 4
This is where you start to quietly move your chair further away from her bed – quietly move it two feet away and sit for a couple of minutes; then move it to the middle of the room for a couple of minutes; and then move to beside the door. Once you’re in this spot, sit for 10 minutes to make sure she's sleeping deeply. If you think she is, move your chair outside the door and give it another couple of minutes if you feel it’s necessary.
Keep up the good work
You’ll need to sit with your daughter and repeat this procedure every time she wakes in the night until she has gone back to sleep again. You can customise this technique to suit you better – for example, you might want to sit by the bed on your chair, or lean against the wall until you’re sure she is asleep. Depending on how well she’s coping, repeat each single step for three nights only and keep any interaction with her to a minimum.
This sleep method normally takes around three or four weeks to complete. It’s likely to be challenging and frustrating for the first few nights, but eventually your daughter will learn to settle herself and you shouldn’t be hearing the pitter patter of tiny feet late at night!  
Nightmares
Nightmares are quite common. They often begin between the ages of 18 months and three years. Nightmares aren’t usually a sign of emotional disturbance. They may happen if your child is anxious about something or has been frightened by a TV programme or story. Be sure they have a relaxing hour or so before bed so they can wind down. After a nightmare, your child will need comfort and reassurance. If your child has a lot of nightmares and you don’t know why, talk to your GP or health visitor. You may want to talk to your child to see if anything is worrying them and triggering their nightmares. It also helps to ensure they have a relaxing bedtime routine.
If your child is older and having frequent nightmares, you may need advice from a psychologist (see your GP for a referral).